Pacer Prep Application & Registration Forms

Printer-friendly version

First, you will need to complete the Student Application and Parental Agreement and mail them along with the non-refundable $200 application fee.

Click here to download the Student Application/Parental Agreement form (PDF)

Once you have been accepted into the program, you will need to complete the form below to register. To secure your place, you must also send a check for the initial payment of $4500: a $3500 down payment + the first month's payment of $1000, payable to Pacer Prep. Mail your payment to:

XCELERATED PERFORMANCE
ATTN: HAYWARD STATUM II
2727 ELECTRIC RD BASEMENT
ROANOKE, VA 24018

PACER PREP REGISTRATION

Name: *

Age: *

E-Mail Address: *

Street Address: *

City: *

State or Province: *

Country (if not U.S.):

Date of Birth: *

Home Phone: *

Cell Phone:

Comments/Additional Information:

WAIVER

To sign, type your name below: * I,

understand that the weight, basketball and skills development may be hazardous, and may result in accident, bodily injury, death or damage to property. I acknowledge that although my basketball Academy may provide advice, instruction, or consultation on the nature and methods of exercise, the sole decision and responsibility is mine. I affirm that I am physically fit for the activities engaged in. I waive and release any and all right, claims for liability, or other causes for action, for any kind including death, suffered by me arising out or in connection of my use of equipment or facilities of or participation in any activity.

Recent Game Results

Impact Academy vs Pacers

01/29/2011

Game Results: 52-44 Won
Pacers vs New Horizon

01/28/2011

Game Results: 83-59 Won
Mt. Zion vs Pacers

01/27/2011

Game Results: 62-55 loss